Transanal excision with adjuvant therapy for pT1N0 rectal tumors with high‐risk features offers equivalent survival to radical resection: A National Cancer Database analysis. Issue 3 (27th October 2021)

• Record Type: Journal Article
• Authors: Hrebinko, Katherine A.; Reitz, Katherine M.; Mohammed, Maryam K.; Nassour, Ibrahim; Watson, Andrew R.; Cunningham, Kellie E.; Medich, David S.; Celebrezze, James P.; Holder‐Murray, Jennifer M.
• Is Part Of: Journal of surgical oncology. Volume 125:Issue 3(2022)
• Page Start: 475
• Page End: 483
• Publication Date: 2021-10-27
• Subjects: adenocarcinoma -- digestive system surgical procedures -- morbidity -- rectal neoplasms; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26734
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Current guidelines favor transabdominal radical resection (RR) over transanal local excision (TAX) followed by adjuvant therapy (TAXa) for pT1N0 rectal tumors with high‐risk features. Comparison of oncologic outcomes between these approaches is limited, although the former is associated with increased postoperative morbidity. We hypothesize that such treatment strategies result in equivalent long‐term survival. Methods: A retrospective cohort study was conducted using the National Cancer Database (2010–2016) to identify patients with pT1N0 rectal adenocarcinoma with high‐risk features who underwent TAX or RR for curative intent. The primary outcome was 5‐year overall survival (OS), evaluated with log‐rank and Cox‐proportional hazards testing. Results: A total of 1159 patients (age 67.4 ± 12.9 years; 56.6% male; 83.3% White) met study criteria, of which 1009 (87.1%) underwent RR and 150 (12.9%) underwent TAXa. Patients undergoing TAXa had shorter lengths of stay (RR = 6.5 days, TAXa = 2.7 days, p < 0.001). The 5‐year OS was equivalent between groups. TAX without adjuvant therapy was associated with an increased risk of mortality (hazard ratio 1.81, 95% confidence interval 1.17–2.78, p = 0.01). Conclusions: This is the largest study to demonstrate equivalent 5‐year OS between TAXa and RR for T1N0 rectal cancer with high‐risk features. These findings may guide the development of prospective, randomized trials and influence changes in practice recommendations for early‐stage rectal cancer.